Provider Demographics
NPI:1407748734
Name:TESORIERO, NICOLE ROSE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ROSE
Last Name:TESORIERO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:ROSE
Other - Last Name:TESORIERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NICOLE TESORIERO RN
Mailing Address - Street 1:7 CARSTON ST W
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2318
Mailing Address - Country:US
Mailing Address - Phone:631-627-4487
Mailing Address - Fax:631-627-4487
Practice Address - Street 1:7 CARSTON ST W
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2318
Practice Address - Country:US
Practice Address - Phone:631-627-4487
Practice Address - Fax:631-627-4487
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY917395163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse